title: How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: role of radiofrequency ablation.
abstract: OBJECTIVE
  Although ethanol ablation (EA) is effective in the treatment of cystic thyroid nodules, it is less effective in nodules with solid component. Therefore refractory cases with solid component require another treatment modality such as radiofrequency ablation (RFA), which is effective in both solid and cystic thyroid nodules. We prospectively evaluated the efficacy of additional RFA and factors related to volume reduction in patients showing unsatisfactory results after a single session of EA.
  
  
  METHODS
  Of 94 patients with predominantly cystic thyroid nodules who underwent EA, 20 patients underwent additional RFA because of incompletely resolved clinical problems (symptomatic score reduction <50%) and presence of residual solid component at 1-month follow-up on ultrasonography. Improvement of clinical symptoms and nodule volume reduction were evaluated 6 month later. We evaluated factors related to nodule volume reduction after EA and RFA.
  
  
  RESULTS
  RFA after a single session of EA was effective in reducing mean symptom score from 4.8 to 1.1 (p<0.001), mean cosmetic score from 3.5 to 1.4 (p<0.001) and mean nodule volume from 11.3 to 0.9 mL (p<0.001). The only independent factor related to volume reduction after EA was the presence of a solid component (p<0.001), and EA was less effective in nodules when solid component >20% (p=0.001). We identified no factors related to volume reduction after RFA.
  
  
  CONCLUSIONS
  RFA is effective in treatment of benign predominantly cystic thyroid nodules in patients whose clinical problems were incompletely resolved after EA.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Seung Won
authors.initials: SW
authors.lastname: Jang
authors.forename: Jung Hwan
authors.initials: JH
authors.lastname: Baek
authors.forename: Jae Kyun
authors.initials: JK
authors.lastname: Kim
authors.forename: Jin Yong
authors.initials: JY
authors.lastname: Sung
authors.forename: Hoon
authors.initials: H
authors.lastname: Choi
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Lim
authors.forename: Jee Won
authors.initials: JW
authors.lastname: Park
authors.forename: Ha Young
authors.initials: HY
authors.lastname: Lee
authors.forename: Soonchan
authors.initials: S
authors.lastname: Park
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D003560:Cysts / Q000175:diagnosis / Q000628:therapy*; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016606:Thyroid Nodule / Q000175:diagnosis / Q000628:therapy*; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000431:Ethanol